Department of Laboratory Medicine, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Department of Laboratory Medicine, The Second Haining People's Hospital, Haining, Zhejiang, China.
Medicine (Baltimore). 2024 Sep 27;103(39):e39736. doi: 10.1097/MD.0000000000039736.
Cancer-related anemia (CRA) is a common comorbidity in cancer patients, and it can lead to a worse prognosis. The aim of this cross-sectional study is to investigate the clinical value of the red cell size factor (Rsf) in the early diagnosis of nondigestive tract CRA. A total of 231 patients with nondigestive tract solid cancer were included, and they were divided into anemic and nonanemic subjects according to the hemoglobin (Hb) levels. A BC-7500 blood analyzer was used to detect the indices of red blood cell and reticulocyte, and the mean corpuscular volume (MCV), mean reticulocyte volume (MRV), reticulocyte hemoglobin (RHE) content, and reticulocyte production index were observed. Subsequently, the Rsf was calculated. Receiver operating characteristic curve analysis was used to evaluate the identifying power of Rsf for anemia diagnosed by the combination of RHE and reticulocyte production index. The adjusted-multivariate analysis and quartiles were used to assess the relation of reduced Rsf level with the risk and incidence of anemia diagnosed by combining the MCV, MCH, and mean corpuscular hemoglobin concentration (MCHC), respectively. Rsf levels showed no statistical differences between anemia and nonanemia subjects grouped by Hb (P > .05). Rsf has a high correlation with the RHE level (R > 0.900, P < .001), or MCV, mean corpuscular hemoglobin (MCH), and MCHC in anemia patients (r: 0.435-0.802, P < .001). Receiver operating characteristic curves showed that Rsf had the highest overall area under curve of 0.886 (95% confidence interval: 0.845-0.927) in identifying anemia of cancer patients (P < .001). When the optimal cutoff values of Rsf were set at 97.05 fl in males and 94.95 fl in females, the sensitivity and specificity were 0.94 and 0.76, and 0.98 and 0.75, respectively. Being treated as a categorical variable, Rsf had a highest odds ratio value of 30.626 (12.552-74.726; P < .001) for the risk of anemia. The increment of Rsf quartiles was highly associated with the decreased incidence of overall anemia (P trend < 0.001). The study suggests that decreased Rsf level is a potentially powerful predictor of overt anemia in nondigestive tract cancer, and it can be used as a convenient, practical, cost-free, and sensitive index in early diagnosis of nondigestive tract CRA.
癌症相关性贫血（CRA）是癌症患者常见的合并症，可导致预后更差。本横断面研究旨在探讨红细胞大小因子（Rsf）在非消化道 CRA 早期诊断中的临床价值。共纳入 231 例非消化道实体瘤患者，根据血红蛋白（Hb）水平将其分为贫血和非贫血组。使用 BC-7500 血液分析仪检测红细胞和网织红细胞指数，观察平均红细胞体积（MCV）、平均网织红细胞体积（MRV）、网织红细胞血红蛋白含量（RHE）和网织红细胞生成指数。随后计算 Rsf。采用受试者工作特征曲线分析评估 Rsf 对 RHE 和网织红细胞生成指数联合诊断贫血的鉴别能力。调整多变量分析和四分位数用于评估降低 Rsf 水平与 MCV、MCH 和平均红细胞血红蛋白浓度（MCHC）联合诊断贫血的风险和发生率的关系。Rsf 水平在 Hb 分组的贫血和非贫血组之间无统计学差异（P＞.05）。Rsf 与贫血患者的 RHE 水平高度相关（R＞0.900，P＜.001），或与 MCV、平均红细胞血红蛋白（MCH）和 MCHC 相关（r：0.435-0.802，P＜.001）。受试者工作特征曲线显示，Rsf 在识别癌症患者贫血方面的曲线下总面积最高，为 0.886（95%置信区间：0.845-0.927）（P＜.001）。当 Rsf 的最佳截断值分别设定为男性 97.05 fl 和女性 94.95 fl 时，灵敏度和特异性分别为 0.94 和 0.76，0.98 和 0.75。作为分类变量，Rsf 的比值比最高值为 30.626（12.552-74.726；P＜.001），提示贫血风险增加。Rsf 四分位间距的增加与总体贫血发生率的降低高度相关（P趋势＜.001）。该研究表明，降低 Rsf 水平是消化道外癌症显性贫血的潜在有力预测因子，可作为非消化道 CRA 早期诊断的一种方便、实用、免费和敏感的指标。
